Riedel's thyroiditis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Riedel's thyroiditis}}
[[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Riedel%27s_thyroiditis]]
{{CMG}} {{AE}} {{MMF}}
{{CMG}} {{AE}} {{MMF}}


==Overview==
==Overview==
[[Riedel's thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Hashimoto's thyroiditis]], and suppurative thyroiditis.
Riedel's thyroiditis must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis.
==Differentiating Hashimoto's Thyroiditis from other Diseases==
==Differentiating Riedel's Thyroiditis from other Diseases==
*[[Riedel's thyroiditis]] must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Hashimoto's thyroiditis]], and suppurative thyroiditis.<ref name="urlThyroiditis — NEJM">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMra021194 |title=Thyroiditis — NEJM |format= |work= |accessdate=}}</ref>
*Riedel's thyroiditis must be differentiated from other causes of [[thyroiditis]], such as [[De Quervain's thyroiditis]], [[Hashimoto's thyroiditis]], [[Riedel's thyroiditis]], and suppurative thyroiditis.<ref name="urlThyroiditis — NEJM">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMra021194 |title=Thyroiditis — NEJM |format= |work= |accessdate=}}</ref>
 
<br>
{| align="center"
{| align="center"
|-
|-
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! style="background:#4479BA; color: #FFFFFF;" |Age at onset
! style="background:#4479BA; color: #FFFFFF;" |Age at onset
! style="background:#4479BA; color: #FFFFFF;" |Pathological findings
! style="background:#4479BA; color: #FFFFFF;" |Pathological findings
! style="background:#4479BA; color: #FFFFFF;" |Diagnostic approach 
! style="background:#4479BA; color: #FFFFFF;" |Diagnostic findings   
 
|-
|-
| align="center" style="background:#DCDCDC;" |[[Riedel's thyroiditis]]
| align="center" style="background:#DCDCDC;" |[[Riedel's thyroiditis]]
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| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis]]
| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Autoimmune
*[[Autoimmunity|Autoimmune]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*All ages, peak at 30-50
*All ages, peak at 30-50
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Lymphocytic infiltration
*Lymphocytic infiltration
*Germinal centers
*[[Germinal center|Germinal centers]]
*Fibrosis (in some variants)
*[[Fibrosis]] (in some variants)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Increased TSH]] (hypothyroidism)
*[[Thyroid function tests|Increased TSH]] ([[hypothyroidism]])
*[[Thyroid peroxidase|TPO antibodies]] present in high titer
*[[Thyroid peroxidase|TPO antibodies]] present in high titer
*[[I-123 thyroid imaging|I-123]] uptake usually decreased
*[[I-123 thyroid imaging|I-123]] uptake usually decreased
|-
|-
|-
| align="center" style="background:#DCDCDC;" |[[De Quervain's thyroiditis|Painful subacute (De Quervain's) thyroiditis]]
| align="center" style="background:#DCDCDC;" |[[De Quervain's thyroiditis|Painful subacute (De Quervain's) thyroiditis]]
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Giant cells
*Giant cells
*Granulomas
*[[Granuloma|Granulomas]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Increased TSH]] (hypothyroidism) and/or
*[[Thyroid function tests|Increased TSH]] ([[hypothyroidism]]) and/or
* [[Thyroid function tests|Decreased TSH]] (Thyrotoxicosis)
* [[Thyroid function tests|Decreased TSH]] ([[Hyperthyroidism|Thyrotoxicosis]])
*[[Thyroid peroxidase|TPO antibodies]] absent or very low titer
*[[Thyroid peroxidase|TPO antibodies]] absent or very low titer
*[[I-123 thyroid imaging|I-123]] uptake decreased
*[[I-123 thyroid imaging|I-123]] uptake decreased
|-
| align="center" style="background:#DCDCDC;" |[[Silent thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Autoimmunity|Autoimmune]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*All ages, peak at 30-40
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Lymphocytic infiltration
*Lymphoid follicles
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Increased TSH]] ([[hypothyroidism]]) and/or
* [[Thyroid function tests|Decreased TSH]] (transient [[hypothyroidism]])
*[[Thyroid peroxidase|TPO antibodies]] present in high titer
*[[I-123 thyroid imaging|I-123]] uptake usually decreased
|-
| align="center" style="background:#DCDCDC;" |[[Postpartum thyroiditis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Autoimmunity|Autoimmune]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Childbearing age
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Lymphocytic infiltration
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Increased TSH]] (hypothyroidism) and/or
* [[Thyroid function tests|Decreased TSH]] (transient hypothyroidism)
*[[Thyroid peroxidase|TPO antibodies]] present in high titer
*[[I-123 thyroid imaging|I-123]] uptake usually decreased
|-
|-
| align="center" style="background:#DCDCDC;" |[[Suppurative thyroiditis]]
| align="center" style="background:#DCDCDC;" |[[Suppurative thyroiditis]]
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*Children, 20-40
*Children, 20-40
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Abscess formation
*[[Abscess]] formation
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Thyroid function tests|Normal TSH]] (euthyroidism)
*[[Thyroid function tests|Normal TSH]] (euthyroidism)
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|}
|}


<br style="clear:left" />
*Riedel's thyroiditis must be differentiated from other causes of [[hypothyroidism]] on the basis of history and symptoms and laboratory findings:<ref name="pmid16734054">{{cite journal |vauthors=Bindra A, Braunstein GD |title=Thyroiditis |journal=Am Fam Physician |volume=73 |issue=10 |pages=1769–76 |year=2006 |pmid=16734054 |doi= |url=}}</ref><ref name="pmid19949140">{{cite journal |vauthors=McDermott MT |title=In the clinic. Hypothyroidism |journal=Ann. Intern. Med. |volume=151 |issue=11 |pages=ITC61 |year=2009 |pmid=19949140 |doi=10.7326/0003-4819-151-11-200912010-01006 |url=}}</ref><ref name="urlThyroiditis — NEJM">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMra021194 |title=Thyroiditis — NEJM |format= |work= |accessdate=}}</ref><ref name="pmid18177256">{{cite journal |vauthors=Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR |title=Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002) |journal=Thyroid |volume=17 |issue=12 |pages=1211–23 |year=2007 |pmid=18177256 |doi=10.1089/thy.2006.0235 |url=}}</ref><ref name="pmid18415684">{{cite journal |vauthors=Lania A, Persani L, Beck-Peccoz P |title=Central hypothyroidism |journal=Pituitary |volume=11 |issue=2 |pages=181–6 |year=2008 |pmid=18415684 |doi=10.1007/s11102-008-0122-6 |url=}}</ref><ref name="pmid25905413">{{cite journal |vauthors=De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Stockigt J |title=Clinical Strategies in the Testing of Thyroid Function |journal= |volume= |issue= |pages= |year= |pmid=25905413 |doi= |url=}}</ref>
 
{| class="wikitable" align="center" style="border: 0px; margin: 3px;"
! colspan="2" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease
! colspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |History and symptoms
! colspan="7" align="center" style="background: #4479BA; color: #FFFFFF; " |Laboratory findings
! rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Additional findings
|-
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Fever 
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Pain
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TSH
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Free T4
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> T3RU<small><sup>†</sup>
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> Thyroglobin
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TRH
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TPOAb<sup>^</sup>
|-
| rowspan="3" style="background:#DCDCDC;" |[[Primary hypothyroidism]]
| align="center" style="background:#DCDCDC;" |[[Riedel's thyroiditis]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Usually present
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*[[Riedel's thyroiditis]] usually presents with hard and fixed thyroid mass.
|-
| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis|Autoimmune]] ([[Hashimoto's thyroiditis]])
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''<small>*
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer)
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* May be accompanied by other [[autoimmune diseases]]
|-
| align="center" style="background:#DCDCDC;" |[[Thyroiditis|Infectious thyroiditis]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*[[Thyroiditis|Infectious thyroiditis]] associated with [[neck pain]]
|-
| rowspan="3" style="background:#DCDCDC;" |[[Hypothyroidism|Transient hypothyroidism]]
| align="center" style="background:#DCDCDC;" |[[De Quervain's thyroiditis|Subacute (de Quervain's) thyroiditis]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Low/absent
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*May present primarily with [[hyperthyroidism]]
|-
| align="center" style="background:#DCDCDC;" |[[Postpartum thyroiditis]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer)
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*May present primarily with [[hyperthyroidism]]
|-
| align="center" style="background:#DCDCDC;" |[[Silent thyroiditis]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑/'''↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |↑
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Present (high titer)
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
*May present primarily with [[hyperthyroidism]]
|-
| rowspan="8" style="background:#DCDCDC;" |Others
| align="center" style="background:#DCDCDC;" |Drug-induced
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''/↓
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''/↑
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |↓
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| rowspan="5" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Absent**
| rowspan="5" align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* History of [[hyperthyroidism]]
* History of trauma
*History of drug use, surgery, or radiation
|-
| align="center" style="background:#DCDCDC;" |Radiation-induced
|-
| align="center" style="background:#DCDCDC;" |Trauma induced
|-
| align="center" style="background:#DCDCDC;" |[[Iodine-131|Radioiodine]] induced
|-
| align="center" style="background:#DCDCDC;" |Thyroidectomy
|-
| align="center" style="background:#DCDCDC;" |Subclinical [[hypothyroidism]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* Asymptomatic
|-
|}
<br style="clear:left" />''†: T3RU; Triiodothyronine Resin uptake''
 
''^: TPOAb; [[Thyroid peroxidase]] antibodies''
 
''*: [[TSH]] may be decreased transiently in the [[thyrotoxicosis]]''
 
''**: TPOAb may be present in drug-induced [[Hypothyroidism|hypo]]/[[hyperthyroidism]] such as [[Interferon-alpha]], [[Interleukin 2|interleukin-2]], and [[lithium]].''
 


==References==
==References==
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[[Category:Needs content]]
 
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[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Up-To-Date]]

Latest revision as of 00:01, 30 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]

Overview

Riedel's thyroiditis must be differentiated from other causes of thyroiditis, such as De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis, and suppurative thyroiditis.

Differentiating Riedel's Thyroiditis from other Diseases

Conditions Causes Age at onset Pathological findings Diagnostic findings
Riedel's thyroiditis
  • Unknown
  • 30-60
  • Dense fibrosis
Hashimoto's thyroiditis
  • All ages, peak at 30-50
Painful subacute (De Quervain's) thyroiditis
  • Unknown
  • 20-60
Silent thyroiditis
  • All ages, peak at 30-40
  • Lymphocytic infiltration
  • Lymphoid follicles
Postpartum thyroiditis
  • Childbearing age
  • Lymphocytic infiltration
Suppurative thyroiditis
  • Infection
  • Children, 20-40
Disease History and symptoms Laboratory findings Additional findings
Fever Pain TSH Free T4 T3 T3RU Thyroglobin TRH TPOAb^
Primary hypothyroidism Riedel's thyroiditis - - Normal/↑ Normal/↓ Normal/↓ Normal/↓ Normal Normal Usually present
Autoimmune (Hashimoto's thyroiditis) - - * Normal/ Normal/↓ Normal/ Normal Present (high titer)
Infectious thyroiditis + + Normal Normal Normal Normal Normal Normal Absent
Transient hypothyroidism Subacute (de Quervain's) thyroiditis +/- +/- ↑/ ↓/ Normal Normal Low/absent
Postpartum thyroiditis +/- +/- ↑/ ↓/ Normal Normal/↑ Present (high titer)
Silent thyroiditis - - ↑/ ↓/ Normal Normal Present (high titer)
Others Drug-induced - - /↓ /↑ Normal Normal/ Normal Absent**
  • History of hyperthyroidism
  • History of trauma
  • History of drug use, surgery, or radiation
Radiation-induced
Trauma induced
Radioiodine induced
Thyroidectomy
Subclinical hypothyroidism - - Normal Normal Normal Normal Normal Normal/
  • Asymptomatic


†: T3RU; Triiodothyronine Resin uptake

^: TPOAb; Thyroid peroxidase antibodies

*: TSH may be decreased transiently in the thyrotoxicosis

**: TPOAb may be present in drug-induced hypo/hyperthyroidism such as Interferon-alpha, interleukin-2, and lithium.


References

  1. 1.0 1.1 "Thyroiditis — NEJM".
  2. Bindra A, Braunstein GD (2006). "Thyroiditis". Am Fam Physician. 73 (10): 1769–76. PMID 16734054.
  3. McDermott MT (2009). "In the clinic. Hypothyroidism". Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.
  4. Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR (2007). "Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002)". Thyroid. 17 (12): 1211–23. doi:10.1089/thy.2006.0235. PMID 18177256.
  5. Lania A, Persani L, Beck-Peccoz P (2008). "Central hypothyroidism". Pituitary. 11 (2): 181–6. doi:10.1007/s11102-008-0122-6. PMID 18415684.
  6. De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Stockigt J. "Clinical Strategies in the Testing of Thyroid Function". PMID 25905413.

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